I've noticed an increase in pain in my right wrist (palm side). It usually only happens when I'm doing certain things. The motion that causes the most pain is when I'm pumping up my tires with a floor pump. When I have to use my right thumb to close the valve it sends a sharp pain up the inside of my wrist. It seems to be getting worse alhough it's been going on for a few months. Please tell me that it's something that doesn't require me to be off my bike for ANY length of time! Thanks!

It is a bad omen when someone says to a doctor,"Please don't tell me I have to stop...."

Your symptoms could be consistent with carpal tunnel syndrome. The median nerve runs through the carpal tunnel, the base is formed by the wrist (carpal) bones and the roof is formed by the carpal fibrous ligaments that cross over the top of the bones. The median nerve can become compressed by swelling to the carpal tunnel. Repetitive trauma, diabetes, arthritis, acute injury and other things can cause carpal tunnel syndrome. Symptoms are characterized by numbness, tingling pain and or weakness to the distribution of the median nerve: the thumb, index finger, middle finger and the aspect of the ring finger next to the middle finger. Occasionally the pain can go retrograde back up the median nerve to the elbow and shoulder.

Treatment consists of resting the wrist form repetitive use injury (yikes off the bikes!), using a wrist splint to prevent hyper- flexion or extension of the wrist, a course of anti-inflammatory medications, occasional steroid injection within the carpal tunnel and in reticent cases, surgery to release the fibrous band of the carpal roof. If there are signs of muscle weakness such as decreased size of the muscle in the thumb side of the heal of the hand or weakness in the hand grip or uncontrollable pain, then surgery is indicated.

Things that you can do to help your carpal tunnel in relation to your bike are the following:

1. Raise your handle bars and bring them back with a shorter taller stem or switching to riser bars with more back sweep
2. Set up your front suspension on your MTB to a softer setting to isolate your hands from high frequency low impact vibration
3. On a road bike look at getting a suspension stem or even a suspension fork
4. Switch from Grip Shifters to thumb shifter (those of you who read my columns regularly know I am a great fan of the durable, simple twist shifters but there are times when I cannot recommend them)
5. Get rid of your conventional road bike and switch to a recumbent (check out www.bentrideronline.com for a start on recumbency literacy and enlightenment). I had been afflicted from carpal tunnel syndrome from my conventional road bike. I was looking to go under the knife but spent the money on a recumbent instead. What a relief it was! Now I am 'bent happy!
6. Put bar ends on your mountain bike and switch hand positions frequently.
7. Get a large volume pump that has broad grips and easy of pumping. I like the Jo-Blow Pro.
8. Put fatter tires on your road and mountain bike to damp the vibrations.

Now if you have any of the above described serious symptoms do not hesitate to get a medical evaluation by a physician. Delays in treatment of serious carpal tunnel syndrome can lead to irreversible nerve damage and loss of muscle strength.

I've already gotten rid of the road bike/ I already have pretty fat tires on both my single speed as well as my MTB/ I try to switch hand positions frequently/ I already have thumb shifters. I don't have any constant pain of discomfort. sometimes when I ride my wrists hurt but I think that's because I get tired and put most of my weight on my hands. I'll try the other adjustments that you listed and see what happens.... Thanks for your quick response.

One other trick you might consider, on your handlebar swap, get a bar with more back sweep. The standard handlebar back sweep of 3-5 degrees may not be enough to place your wrists in a neutral position. Do this little test: sit on your bike, flex your elbows about 45 degrees, your shoulder-upper arm also flexed outward (abducted) about 45 degrees and reach for the bar grips. The distance from the outer edge of your hands should approximate the width of your shoulders. Let your hands and wrist assume a position they feel most comfortable. Look at that position. Now try to reproduce that position with your new handlebar set up. Trim the bar width to what is most comfortable for your shoulders, elbows and wrists. You do not have to stay with the stock width of the bars.

I did this trick and found I needed more back sweep to get my hands and wrist in a neutral position. An 11 degree back sweep bar (Salsa Flat Tracker) was required to get the degree of back sweep to put my wrist in a neutral position. To match my shoulder width and to improve my comfort in my elbows and wrist, I trimmed off and inch on either side of the bar. That simple change markedly improved my wrist and shoulder comfort level on my mountain bike.